Bubble Sign to Confirm the Integrity of the Shoulder Rotator Cuff.
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ABSTRACT:
SUBMITTER: Simon MJK
PROVIDER: S-EPMC7528655 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Purpose To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR). Methods Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result. Results A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P = .005 to P = .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P = .005) and external rotation (7.13° vs 1.65°; P = .031) ROM than the control group. Conclusions Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores. Level of Evidence Level III retrospective comparative study.
| S-EPMC10413075 | biostudies-literature
Project description:The comma sign was described as an arthroscopic landmark to identify the torn subscapularis stump to mobilize and repair the tendon in anterosuperior rotator cuff tears. It was hypothesized that it is composed of the humeral attachments of the superior glenohumeral and coracohumeral ligaments. This arthroscopic finding has since become accepted orthopaedic nomenclature pathognomonic for subscapularis tears and a key component of subscapularis tear classification. We propose an alternative theory of the pathoanatomy of the comma sign in anterosuperior rotator cuff tears and present the technique of comma sign-directed repairs of combined subscapularis and supraspinatus lesions. After appropriate releases, tendon-to-tendon repair of the distal-superior aspect of the comma sign to the upper border of the remnant subscapularis results in anatomic re-creation of the intra-articular portion of the torn subscapularis with concomitant reduction of the anterior leading edge of the supraspinatus and reconstitution of the rotator cable complex. A tension-free, single-anchor subscapularis repair is then performed to secure the tendon to the lesser tuberosity. After subscapularis repair, the supraspinatus that was previously retracted to the glenoid rim takes the appearance of a crescent-type tear that is easily approximated to its anatomic insertion.
| S-EPMC4314558 | biostudies-other
Project description:Rotator cuff tears often heal poorly, leading to re-tears after repair. This is in part attributed to the low proliferative ability of the resident cells (tendon fibroblasts and tendon-stem cells) upon injury to the rotator cuff tissue and the low vascularity of the tendon insertion. In addition, surgical outcomes of current techniques used in clinical settings are often suboptimal, leading to the formation of neo-tissue with poor biomechanics and structural characteristics, which results in re-tears. This has prompted interest in a new approach, which we term as "Regenerative Engineering", for regenerating rotator cuff tendons. In the Regenerative Engineering paradigm, roles played by stem cells, scaffolds, growth factors/small molecules, the use of local physical forces, and morphogenesis interplayed with clinical surgery techniques may synchronously act, leading to synergistic effects and resulting in successful tissue regeneration. In this regard, various cell sources such as tendon fibroblasts and adult tissue-derived stem cells have been isolated, characterized, and investigated for regenerating rotator cuff tendons. Likewise, numerous scaffolds with varying architecture, geometry, and mechanical characteristics of biologic and synthetic origin have been developed. Furthermore, these scaffolds have been also fabricated with biochemical cues (growth factors and small molecules), facilitating tissue regeneration. In this Review, various strategies to regenerate rotator cuff tendons using stem cells, advanced materials, and factors in the setting of physical forces under the Regenerative Engineering paradigm are described.
| S-EPMC8500337 | biostudies-literature
Project description:This study examines the association between strength measurements and supraspinatus tear in patients with shoulder pain. This study characterized determinants of abduction strength among patients with tears.A total of 208 patients with shoulder pain were recruited. Strength was tested using a handheld dynamometer. Supraspinatus tears were diagnosed by combination of clinical assessment and blinded magnetic resonance imaging review. Associations of supraspinatus tear with patient characteristics and strength measurements (abduction, internal rotation and external rotation) were assessed using multivariable logistic regression models.Patients with supraspinatus tear had decreased abduction strength (P = 0.02) and decreased external rotation strength (P < 0.01). When adjusted for age, sex, tear laterality, and body mass index, decreased abduction strength (odds ratio, 1.18/kg; 95% confidence interval, 1.06-1.32) and decreased external rotation strength (odds ratio, 1.29/kg; 95% confidence interval, 1.14-1.48) were associated with supraspinatus tear. In patients with tear, age 60 yrs or older, female sex, and visual analog scale pain score were significantly associated with decreased abduction strength but tear size, fatty infiltration, and atrophy were not.Decreased abduction and external rotation strength were associated with supraspinatus tear in patients with shoulder pain. In this cohort, the abduction strength of patients with tears was influenced by demographic factors but not tear characteristics.
| S-EPMC4713123 | biostudies-literature
Project description: Not available
| S-EPMC7173708 | biostudies-literature
Project description:Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.
| S-EPMC8245121 | biostudies-literature
Project description:Massive tears of the rotator cuff can result in severe functional deficits due to loss of the axial force couple and effective fulcrum that the intact cuff normally provides. For massive, irreparable rotator cuff tears, especially in the setting of early to moderate degenerative changes, reverse total shoulder arthroplasty functions to modify the center of joint rotation, allowing the deltoid and intact components of the cuff to carry out shoulder function more effectively. Our preferred technique uses a standard open deltopectoral shoulder approach with a 3-dimensional glenoid baseplate model and a 135° prosthesis in an onlay configuration to reduce the risk of scapular notching and increase lateralization of the humerus.
| S-EPMC9244853 | biostudies-literature
Project description:BackgroundHumeral rotation often remains compromised after nonlateralized reverse shoulder arthroplasty (RSA). Reduced rotational moment arms and muscle slackening have been identified as possible reasons for this impairment. Although several clinical studies suggest lateralized RSA may increase rotation, it is unclear whether this is attributable to preservation of rotational moment arms and muscle pretension of the remaining rotator cuff.Questions/purposesThe lateralized RSA was analyzed to determine whether (1) the rotational moment arms and (2) the origin-to-insertion distances of the teres minor and subscapularis can be preserved, and (3) their flexion and abduction moment arms are decreased.MethodsLateralized RSA using an 8-mm resin block under the glenosphere was performed on seven cadaveric shoulder specimens. Preimplantation and postimplantation CT scans were obtained to create three-dimensional shoulder surface models. Using these models, function-specific moment arms and origin-to-insertion distances of three segments of the subscapularis and teres minor muscles were calculated.ResultsThe rotational moment arms remained unchanged for the middle and caudal subscapularis and teres minor segments in all tested positions (subscapularis, -16.1 mm versus -15.8 mm; teres minor, 15.9 mm versus 15.3 mm). The origin-to-insertion distances increased or remained unchanged in any muscle segment apart from the distal subscapularis segment at 0° abduction (139 mm versus 145 mm). The subscapularis and teres minor had increased flexion moment arms in abduction angles smaller than 60° (subscapularis, 2.7 mm versus 8.3 mm; teres minor, -6.6 mm versus 0.8 mm). Abduction moment arms decreased for all segments (subscapularis, 4 mm versus -11 mm; teres minor, -3.6 mm versus -19 mm).ConclusionsAfter lateralized RSA, the subscapularis and teres minor maintained their length and rotational moment arms, their flexion forces were increased, and abduction capability decreased.Clinical relevanceOur findings could explain clinically improved rotation in lateralized RSA in comparison to nonlateralized RSA.
| S-EPMC3563780 | biostudies-literature
Project description:We harvested the blood samples from rotator cuff tear patients with and without shoulder stiffness.Then, circulating exosomes were harvested, and the miRNAs content was analyzed with an aim to idenfity differentially expressed miRNAs.
2021-08-31 | GSE182896 | GEO
Project description:BackgroundShoulder pain and loss of function are classically associated with rotator cuff tears, while paresthesia of the hand is not. We noted anecdotally that paresthesia of the arm was common in patients presenting with rotator cuff tears. The purpose of this study was to determine the prevalence and magnitude of hand paresthesia, its relationship to pain, and how surgery affected these symptoms.MethodsThis prospective cross-sectional study assessed the prevalence and magnitude of shoulder pain and hand numbness and tingling (as assessed by 2 questions from the modified Boston Carpal Tunnel Questionnaire) preoperatively and at 1 week, 6 weeks, 12 weeks, and 6 months postoperatively among 213 consecutive patients who presented for and underwent arthroscopic rotator cuff repair.ResultsThe preoperative levels of prevalence and severity of shoulder pain during rest, overhead activities, and sleep improved by 52%, 22%, and 34%, respectively, compared with those by 6 months postoperatively (P < .05). Seventy-five patients (33%) reported hand paresthesia before surgery. There was a 50% and 60% reduction in the severity of hand tingling and numbness, respectively, by 1 week after surgery (P < .05). The preoperative level of hand numbness (Wald statistic; W = 20) and whether the patient's shoulder problem was caused by a specific injury (W = 6) were predictive of the presence of hand numbness at 6 months after surgery (P < .05).ConclusionThis study showed that many patients who undergo rotator cuff repairs present with hand paresthesia that is associated with their shoulder pain. The prevalence and severity of shoulder pain and hand numbness and tingling improved postoperatively.
| S-EPMC9264141 | biostudies-literature